Anderson, Mickey Dale
Anderson, Mickey Dale is an individual health care provider with primary practice located at 118 Patriot Dr Suite 203, Bardstown KY 40004-9093. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Anderson, Mickey Dale can be contacted via phone (502) 348-5588.Contact Information
Primary practice address
118 Patriot Dr Suite 203
Bardstown KY 40004-9093
Phone: (502) 348-5588
Fax: (502) 348-1046
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 20844 | Kentucky |
Profile Details
| NPI number | 1497728323 |
|---|---|
| LBN Legal business name | Anderson, Mickey Dale |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 10th, 2006 |
| Last updated | May 6th, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1497728323 | NPPES |
| Kentucky | MEDICAID | 64208440 |
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